Evaluates assigned territories and negotiates contracts with physicians, specialists, ancillary providers, and hospitals.
Essential Functions & Responsibilities
- Target potential providers to establish contractual agreements.
- Analyze and evaluate assigned territories for recruitment needs.
- Recruit and contract physicians, specialists, ancillary providers, and hospitals for HN1, including all necessary documentation, i.
e., credentials and site visits.
- Research and solve any questions or concerns that providers may have.
- Negotiate contracts for HN1, including all necessary documentation, i.e., credentials.
- Work with contracted providers to integrate their services into the overall care delivery network.
- Maintain lines of communication with all internal departments and with all participating providers to enlist their assistance in referring potential providers in the Network.
- Organize reports for presentation to senior management staff.
- Support other departments as needed.
- Expedite and research provider utilization data concerning negotiating new rates.
- Conduct site visits of all newly contracted providers.
- Support the Credentialing Department by assisting with the collection of physician credentials for re-credentialing purposes.
- Maintain and update physician files.
- Evaluate claim data on recently contracted providers, ensuring contracts are profitable for the Company.
- Respond to provider inquiries regarding contracts, provider networks, and HN1 operations.
Required Education and Experience
- Associate's degree (A.A.) or equivalent from a two-year college or technical school;
- Two to three years’ experience in a physician's office, HMOs, or other health care institutions.
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